Your I-693 Medical Exam: Know the Steps Before You Schedule

If you’re applying for a green card through adjustment of status, you’ve probably been told to get an I-693 medical exam, and it may be unclear what happens there. In short, a civil surgeon designated by USCIS examines you, reviews your vaccination record, and completes Form I-693. You then submit that sealed form with your green card application.

This guide walks through each step, from the appointment to filing. It also covers what changes when a health finding or a removal case is part of the picture.

What Form I-693 Is and Who Completes It

A civil surgeon completes Form I-693, the Report of Immigration Medical Examination and Vaccination Record. USCIS uses the form to decide whether a health condition makes you inadmissible. The form shows whether you have a Class A or Class B medical condition and whether your vaccinations are complete (USCIS Policy Manual, Chapter 2).

The general rule is clear. Under 8 CFR 245.5, an applicant for adjustment of status must have a medical examination by a designated civil surgeon, whose report setting forth the findings of the mental and physical condition of the applicant, including compliance with section 212(a)(1)(A)(ii) of the Act, is incorporated into the record. A medical examination is not required of an applicant who entered the United States as a nonimmigrant spouse, fiancée, or fiancé of a United States citizen, or as the child of such an alien, as defined in section 101(a)(15)(K) of the Act and § 214.2(k) (the K visa categories), if the applicant was medically examined before, and as a condition of, the issuance of the nonimmigrant visa, provided that the medical examination occurred not more than 1 year prior to the date of application for adjustment of status.

Civil surgeons handle exams for people applying inside the United States. Panel physicians abroad handle most visa applicants overseas (USCIS Policy Manual, Chapter 3).

Your medical form is one part of the adjustment packet. Our adjustment of status overview covers the rest of the filing picture, including Form I-485.

What Happens During the Green Card Medical Exam

During the exam, the civil surgeon checks your physical and mental condition, reviews your vaccination records, and orders any required TB testing. The civil surgeon records the findings. A Class A finding depends on the civil surgeon’s medical diagnosis, not on what you report (USCIS Policy Manual, Chapter 7).

Bring every vaccination record you have. Under USCIS policy, a failure to present documentation of having received vaccinations against vaccine-preventable diseases is a Class A condition, but only for aliens who seek admission as immigrants or adjustment of status to lawful permanent residence (USCIS Policy Manual, Chapter 2). A vaccine the civil surgeon marks as not medically appropriate is waived, and you don’t need a separate waiver application for it (USCIS Policy Manual, Chapter 9).

COVID-19 documents are handled differently now. You aren’t required to submit COVID-19 vaccine documentation for applications pending on or after January 20, 2025 (USCIS Policy Manual, Chapter 9).

A positive TB screen adds steps. A chest X-ray is required, and the civil surgeon can’t sign the form until the required TB steps are complete. That referral, testing, and treatment can be a lengthy process (USCIS Policy Manual, Chapter 6).

What the Civil Surgeon Signs and Why the Sealed Envelope Matters

The civil surgeon signs and dates Form I-693 and completes the required sections. The form must go in a sealed envelope, as its instructions detail (USCIS Policy Manual, Chapter 4).

The signing date matters. USCIS treats the date the civil surgeon signs as the date the exam was completed. Age-based syphilis and gonorrhea testing uses that same date, not the day USCIS decides your case (USCIS Policy Manual, Chapter 6).

The edition of the form matters too. In most cases, only the edition in use when the civil surgeon signs is accepted (USCIS Policy Manual, Chapter 4). An officer should not make you redo the form for a requirement that didn’t apply to you on the signing date, unless the CDC otherwise specifies.

Before your appointment, gather your vaccination records, a list of past diagnoses, and your current medications. Ask the civil surgeon how to handle the sealed envelope before you leave, so it isn’t opened by mistake.

Medical Findings That Can Affect a Green Card Application

A Class A condition makes you inadmissible. A Class B condition does not, on its own, make you inadmissible on health grounds. Class A conditions include certain communicable diseases of public health significance, missing vaccination documentation, certain disorders with harmful behavior likely to recur, and drug abuse or addiction (USCIS Policy Manual, Chapter 2).

Class B conditions are serious or permanent. They may interfere with work, school, or self-care, or require extensive treatment (USCIS Policy Manual, Chapter 2). If the civil surgeon marks only a Class B condition, you are not inadmissible on health grounds (USCIS Policy Manual, Chapter 11).

A Class A finding can change after treatment. If the civil surgeon later reclassifies it as Class B, the applicant is not inadmissible on health grounds (USCIS Policy Manual, Chapter 5).

A waiver request on Form I-601 may need to be filed with the I-485 and I-693, or in response to a Request for Evidence (USCIS Policy Manual, Chapter 12).

A Class A finding can also point to other problems. If harmful behavior tied to a disorder led to convictions, the applicant may face criminal inadmissibility under INA 212(a)(2) (USCIS Policy Manual, Chapter 11).

When to File the I-693 With Form I-485 and How Long It Stays Valid

In most adjustment cases, the completed I-693 goes in with your Form I-485.

For a properly completed form signed by a civil surgeon on or after November 1, 2023, USCIS policy says it can generally be used only for the application it is submitted with, as evidence that the applicant is not inadmissible on health-related grounds for the entire time that application is pending (USCIS Policy Manual, Chapter 4).

A filing can still draw questions. If the form is incomplete, the officer may send a Request for Evidence. The applicant then returns to the civil surgeon to correct the form (USCIS Policy Manual, Chapter 5). An officer may also order a new exam if health concerns come up (USCIS Policy Manual, Chapter 11).

Plan the exam before you file, so the signed form is ready. How long scheduling and results take varies from one case to the next.

Timing the Medical Exam When a Removal Case or BIA Appeal Is Involved

A medical exam answers health questions only. It doesn’t resolve a removal case or a BIA appeal.

Your removal case or BIA appeal follows its own rules and timing. The civil surgeon’s review is a separate step, so don’t assume the exam settles your status.

A criminal record can prompt a second look. If your record shows a significant history of alcohol-related driving arrests the exam didn’t report, USCIS can require a re-examination limited to a mental status evaluation of that record (USCIS Policy Manual, Chapter 7). A criminal conviction should be supported by conviction records or similar evidence, not just the medical report (USCIS Policy Manual, Chapter 11).

Whether and when to file the I-485 and I-693 depends on the facts of your case. Keep copies of every notice and receipt you receive, so you can answer timing questions later.

Our page on whether an I-485 can be filed while a BIA appeal is pending covers one common question. Readers with an in absentia order can also read our page on reopening that order.

If a Health Finding or Removal History Is Complicating Your Case

If a health result or a removal order is making your timing hard to judge, you’re likely carrying a lot of worry right now. Many readers look into this for a spouse, parent, or child, or after a result they didn’t expect.

The situations this page covers include a Class A or Class B finding, a missing vaccination, a signed I-693 you’re unsure how to file, and a removal order that makes filing timing unclear.

AG Immigration Law P.A. focuses on removal defense, adjustment of status, and other immigration matters for clients across the United States. Adriana Gomez is the responsible lawyer for this page.

If your medical exam is tangled up with a removal order or a health result you didn’t expect, reach out to AG Immigration Law P.A. through the contact form, by phone, or on WhatsApp.